Senior Network Pricing Consultant

Primary Responsibilities:
Support network pricing strategies and tactics in collaboration with local network field leaders and network managers
Analyze financial impact of provider contracts
Perform complex financial and pricing analyses to evaluate reimbursement strategies and network configurations across hospital, ancillary, and physician provider types
Evaluate financial impact of corporate initiatives and external regulations
Review payment appendices and develop options for various contracting approaches and methodologies
Communicate financial impact findings and insights to stakeholder groups
Conduct financial and network pricing modeling, analysis, and reporting
Provide mentorship and engage in detailed peer review activities
Perform unit cost and contract valuation analysis to support network contracting and unit cost management strategies
Lead large and complex analytical projects to support key business objectives
Influence pricing strategies and rate development by identifying opportunities or safeguarding favorable structures
Collaborate with Network Management to strategize rates or contract methodologies
Review competitive analysis to determine appropriate provider pricing

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:
Bachelor's degree or equivalent relevant work experience
5+ years of experience in healthcare pricing, financial analysis, network pricing, or healthcare economics
5+ years of analytical experience
3+ years of experience with hospital payment methodologies and healthcare products
Experience developing and interpreting financial and pricing models to support contract valuation and network strategy
Proven advanced Excel skills with demonstrated ability to analyze large, complex datasets efficiently
Proven solid communication skills with experience presenting complex analytical findings to stakeholders
Proven ability to manage multiple priorities and deliver results in a fast paced environment
Proven ability to research and solve problems independently
Proven ability to work Central or Eastern Time Zone hours

Preferred Qualifications:
Experience with provider payment methodologies, including physician, hospital, and ancillary reimbursement
Experience with HPM (Hospital Pricing Model)
Experience leveraging enterprise approved automation or AI tools to improve efficiency in analytical workflows
Knowledge of commercial, Medicare, and Medicaid PPO/HMO revenue and expense patterns
Knowledge of Out of Network pricing, surprise billing regulations, and medical coding (e.g., CPT, DRG, ICD 10)
Proficiency with advanced data modeling tools (e.g., Power Pivot, data models, large databases)
Proven solid consultative, problem solving, and cross functional collaboration skills